MEDICARE: CYNTHIA L KEGOWICZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25600	AZ

General Provider Information

NPI Number	:	1063415529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA L KEGOWICZ M.D.

Provider Business Mailing Address
First Line	:	7301 E 2ND ST
Second Line	:	STE 210
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-5620
Country	:	US
Telephone Number	:	480-882-5679
Fax Number	:	480-946-6997

Provider Business Practice Location Address
First Line	:	7301 E 2ND ST
Second Line	:	STE 210
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-5620
Country	:	US
Telephone Number	:	480-882-5679
Fax Number	:	480-946-6997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	02/08/2012

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